NOLS: Problems Flashcards
Blister
Tx: Hypafix toes to prevent; burn-pad donut existing blisters. Lance low
Subungal Hematoma
Tx: heat needle, push through nailbed.
Wound
Tx
1: direct pressure 3 min w/fingertips
2: pressure dressing bulky gauze+compression
Evacuate: can’t be cleaned/closed, not healing, involves a joint/tendon/ligament, animal bite, crushing, face, impalement, amputation or infection.
Dislocation
S/S: joint doesn’t look right
Tx: PAS + TIL
Evacuate: if it’s the first time. Rapid evacuation if decrease in CSM
Dislocation: Jaw
Tx
1: dresser drawer. Massage first
2: gauze around thumbs
3: thumbs on back molars
4: weight arms
5: ace wrap to support
(Good source: https://www.theadventuremedic.com/dental/am-guide-to-managing-jaw-dislocation-on-expedition/)
Dislocation: Fingers/Toes
Tx: do not reduce at webbing.
Others
1: pull with 10-15 lbs of pressure
2: buddy tape. Spoon works well
Dislocation: Shoulder
S/S: Dip in one shoulder; anterior to front; posterior to back (can cause more damage).
Tx: Coker method or Simpson, which is easier and effective:
1: lay on table with arm hanging
2: hang 3 Nalgene from bicep, gradually
3: massage scapula.
Steps 2-3 could take up to 30 minutes. Once reduction succeeds (normal look, less pain, motion) then:
4: sling & swath
Dislocation: Patella
Often to outside/lateral
Tx
1: Light quad massage
2: Hold patella and guide it back towards center as you straighten the leg.
Fracture
S/S: visibly out-of-place, intense pain, inability to weight, bone is sticking out
Tx
1: Pain meds
2: Clean/irrigate
3: TIL or Pack & Dress
4: Splint
Splint
1: immobolize above and below
2: Padding + rigidity
3: keep it svelt
4: maintain access to CSM
Spine Injury
MOI
1: velocity+sudden stop
2: fall above 3 ft on butt/head
3: fall by someone 65+
4: head trauma+ △LOR
Assume if unresponsive
Croissants at 7 (cervical)
Tacos at 12 (thoracic)
Lasagna at 5 (Lumbar)
S/S: pain, numbness/tingling, weakness/paralysis, s/s shock, bowel/bladder, respiratory distress
Tx
1: protect spine
2: monitor CSMs & Vitals
3: comfort
4: evacuate
Head Injury, Mild
S/S: △LOR, headache
Tx: rest, monitor
Evac: if no improvement w/in 24h
Head Injury, Serious/Fracture
S/S: △LOR, combative, vomiting, HR bounds, RR erratic, BP rises, skin flushed, pupils unequal
Tx: manage ABC, rest on side, elevate head, EVACUATE
Neurological, Seizure
MOI: Alone, epilepsy, heat stroke, HACE, head injury, low blood sugar, low blood sodium
S/S: Starring, Jerking limbs, lose of bowels/bladder control
Tx: no restraint, recovery position, PAS, protect dignity
Evac: if first, associated with injury or illness
Neurological, Stroke
MOI: Interruption of blood to the brain.
TIA: transient ischemic attack <24hr.
CVA: cerebrovascular accident/full stroke.
S/S: sudden severe headache, memory loss, change in speech, one-sided paralysis.
FAST Test: face unequal, arms imbalanced, speech slurred/processing. Time to Go
Tx: fast test, note start time, position of comfort, keep calm, rapid Evac.
Neurological, headache
Evac:
S/S are suddenly or severe
don’t improve with treatment
Paired with altered mental state
Neurological, Syncope
MOI: fainting, often drop in BP
S/S: dizzy, vision change, light-headed
Tx: lay flat, elevate legs, PAS for residual S/S
Neurological, unresponsive
Talk to them, full PAS, check phone/wrist/neck/pockets
What stops the brain?
T: toxins
S: sugar, seizure, stroke
T: temperature
O: oxygen
P: pressure
Tx: recovery position, sugar on the gums, monitor LOR, consider Evac
Neurological, Opioid overdose
MOI: suppression of central nervous system CNS, leading to repression of breath
Tx: Narcan, rescue breaths, recovery position
Shock
MOI: Inadequate delivery of oxygenated blood (perfusion) to the tissues and organs of the body. 3 types:
1: Hypovolemic (fluid loss)
2: Cariogenic (heart failure)
3: Vasogenic (spine injury or anaphylaxis)
S/S: ↑RR + ↑HR + Skin Cool/Pale/Clammy = assume shock
S/S Compensatory: early. Nausea, vomiting, anxious
S/S Decompensatory: ↑RR + ↑HR +↓BP + Skin bluing + △LOR
Rx: Treat cause, manage ABC/body temp/liquids. Keep calm. Elevate feet. Evacuate.
Mental Health
Anxiety S/S: SPCC, ↑RR, ↑HR, Dizzy, Chest tightness or pain
Suicidal: Thoughts? Plan? Means? Time? History?
Rx: Be calm, PAS to rule out physical cause, listen, be honest, beware touch
Diabetes: Hypoglycemia
*Never give Insulin. When in doubt, Give sugar.
MOI: Too little sugar in the blood.
S/S: Fast onset, △LOR, ↑HR, SPCC, Blood sugar<80mg/dl
Rx: Check blood sugar. Offer simple sugar → larger meal
Diabetes: Hyperglycemia
- Never give Insulin. When in doubt, Give sugar.
MOI: Too much sugar + not enough insulin
S/S: Slow onset,↑thirst/hunger/urine, fatigue, ↑RR, Sweet/alcohol breath, → Late LOR “drunken”, Blood sugar > 120mg/dl
Rx: if doubt, give sugar. Hydrate. Consider Evacuation
Cold: Hypothermia, Mild
S/S: Shivering, cold, apathy, “umbles”
Rx: Move, get warm & dry, hot sweet drinks
Cold: Hypothermia, moderate
S/S uncontrollable shivers + “Umbles” + unstable LOR
Tx: As for mild + HypoWrap + sit-ups
Cold: Hypothermia Severe
S/S: no shivering, rigid, unresponsive, HR hard to find
Rx: Move gently. HypoWrap, evacuate. Monitor for sudden ↓BP upon rewarming
Cold: Frostbite
S/S: wooden/waxy skin, blisters, mottled skin
Rx: Don’t rub. Skin-to-skin rewarming. ±100 H2o. Dry+elevate. Evacuate.
Heat: Exhaustion
S/S: nausea, cramps, SPCC, dizzy
Rx: rest, cool down, observe
Heat: Stroke
S/S: nausea, cramps, dizzy + △LOR, skin red/hot, stumbling
Rx: Cool aggressively. Evacuate
Hydration: Dehydration
S/S: Thirst, dark urine, S/S shock, diarrhea
Tx: drink small sips
Hydration: Hyponatremia
S/S: Nausea, vomiting, headache. Late: △LOR
Tx: no more water. Salty snack, No saline IV
Hydration: Rhabdo
Rhabdomyolysis is the breakdown of muscle tissue that releases a damaging protein into the blood. Damages organs. Rare. Effects endurance athletes, firefighters.
S/S: Severe muscle pain, fatigue, cola urine
Tx: Hydrate. Evacuate.
Altitude: AMI
Acute Mountain Illness
S/S: Headache, nausea, vomiting, anorexia, insomnia
Tx: hold elevation, eat, light exercise
Rx: 125 mg acetazolamide/Diamox every 12 hrs
Altitude: HACE
High Altitude Cerebral Edema. Deadly, less common.
S/S: Ataxia is key. Disoriented, irritable, combative. Headache. △Vision, △LOR → Late: unresponsive.
Tx: Rapid decent. Request o2 + hyperbaric/Gamow bag
Rx: 8 mg Dexamethasone + 4 mg/6hr during evac
Altitude: HAPE
High Altitude Pulmonary Endema. Biggest Killer.
S/S: Shortness of breath, dry cough. → wet pink cough + trouble laying back.
Tx: Rapid decent. Request o2 + hyperbaric/Gamow bag
Tx: Albuterol used to be recommended. Not helpful. Not harmful.
Guts: Gastroenteritis
MOI: bacteria or Protozoa
S/S: Nausea, Vomiting, Diarrhea
Rx: Hydrate/electrolytes, bland food, anti-diarrheals, antibiotics.
Evac: Consult Evac Criteria for Gut pain
Guts: Organs by Quadrant
R Upper: Liver, R. Kidney, Gallbladder, Pancreas, Colon
L Upper: Liver, L. Kidney, Spleen, Pancreas, Colon, Stomach
R Lower: Colon, Sm. Intestine, Appendix
L Lower: Colon Sm. Intestine
Guts: Evacuation
Evacuate if: pain inconsistent w/UTI or GI, worsening gastroenteritis>24hr, pregnant, fever, can’t eat/drink
Rapid Evacuation if: 12hr constant/worsening, distensión/rigidity/guarding, foot strike test, blood in urin/vomit/poop, fever>102, S/S shock
Guts: PAS
Sample History first if medical issue: N/V, diarrhea/constipation, blood in vomit/urine/poop, pain, period/stress/history
Head-Toe: pain on palpation or release of palpation, rigidity, guarding, distention, bruising/wounds, pain on footstrike
V/S: △LOR, ↑RR +↑HR, SPCC,↑BP
Allergies: Mild
S/S: swelling, flushed, hives, no breathing issues
TRX: 4 Benadryl + monitor for facial swelling/breathing issues
Allergies: Anaphylaxis
S/S: Breathing distress OR Airway swelling, G/I, S/S shock
Tx: Epinephrine, antihistamines + evacuation
Respiratory & Cardiac: Unconscience
Talk to them, full PAS, check phone/wrist/neck/pockets
What stops the brain?
T: toxins
S: sugar, seizure, stroke
T: temperature
O: oxygen
P: pressure
Tx: recovery position, sugar on the gums, monitor LOR, consider Evac
Respiratory & Cardiac: Hyperventilation
S/S: Anxiety, dizzy, tingly/spasms of hands/feet, chest pain, ↑RR +↑HR
Tx: Calm, coach breathing
Respiratory & Cardiac: Angina
MOI: Chest pain brought on by physical or emotional stress that is relieved by rest and medication
Tx: Rest and monitor. First timers slow walk to the car
Respiratory & Cardiac: Heart Attack
MOI: Hypoxia (lack of oxygen) leading to muscle damage
S/S Classic: crushing chest pain, arm/jaw pain radiating, SPCC, N/V, dizzy, anxious, history/risk factors
S/S Women/Seniors/Diabetics: Shortness of breath w/o pain, heartburn, fainting, weakness, N/V, Altered mental state
Tx: Rest, Calm, CHEW 325mg ASA, Request oxygen. Evacuate.
Rx: Nitroglycerin IF → Rx + Systolic BP ↑100 + NO Rx erectile dysfunction → Wait 5 min → IF Pain>0, Dose. Three dose MAX
